Racism, Coping and Ambulatory Blood Pressure

描述（由申请人提供）：健康状况的种族差异，特别是黑人高血压（HT）的过度发生率，已被广泛认可。研究人员假设，社会压力，包括暴露于种族主义或种族歧视，可能会导致HT和心血管疾病（CVD）的风险增加。拟议的研究的具体目的是测试种族歧视，应对和动态血压（ABP）之间的关系模型。该模型提出，认为暴露于种族歧视将与ABP的平均水平，并与急性血压和心率的幅度和持续时间的反应，目前的负面人际交往。应对方式和策略，用于管理种族歧视，预计调解种族歧视的关系，ABP。社会经济地位（SES）预计将缓和种族主义的关系，应对和种族歧视和应对ABP的关系。为了测试这个模型的普遍性，假设将被测试在一个多站点的样本720美国出生的黑人和拉丁美洲的男性和女性从城市初级保健医疗实践。这些诊所位于文化多样的社区，为来自各种社会经济背景的患者提供服务。参与者将佩戴动态血压监测仪24小时。将使用调查表来评估过去遭受族裔/种族歧视的情况。每次动态血压阅读时完成的日记将用于识别检测日阴性和潜在歧视性相互作用。这两个特点的应对方式和特定事件的策略，以应对种族歧视的检查。人口和个性变量可能会影响种族歧视的看法将进行检查和控制。本研究采用结构方程模式探讨族群歧视知觉与因应方式、ABP的关系。其他分析将探讨性别，SES和种族/民族的关联，以使用不同的风格和策略来应对种族歧视，以及这些特征对应对ABP的关系的影响。这项研究对有关心理社会压力与HT风险关系的理论以及减少健康状况种族差异的干预措施的发展具有影响。

DESCRIPTION (provided by applicant): Racial disparities in health status, and in particular the excess rates of hypertension (HT) among Blacks, are widely recognized. Investigators have hypothesized that social stressors, including exposure to racism or ethnic discrimination, may contribute to increased risk for HT and cardiovascular disease (CVD). The specific aim of the proposed study is to test a model of the relationships among ethnic discrimination, coping, and ambulatory blood pressure (ABP). The model proposes that perceived exposure to ethnic discrimination will be positively associated with the average level of ABP and with the magnitude and duration of acute blood pressure and heart rate responses to current negative interpersonal interactions. Coping styles and strategies used to manage ethnic discrimination are expected to mediate the relationship of ethnic discrimination to ABP. Socioeconomic status (SES) is expected to moderate the relationship of racism to coping and the relationships of ethnic discrimination and coping to ABP. To test the generalizability of this model, the hypotheses will be tested in a multi-site sample of 720 American-born Black and Latino men and women drawn from urban primary care medical practices. These practices are located in culturally diverse communities, serving patients from a range of socioeconomic backgrounds. Participants will wear an ambulatory blood pressure monitor for 24 hours. Questionnaires will be used to assess past exposure to ethnic/racial discrimination. Diaries completed at the time of each ambulatory blood pressure reading will be used to identify day-of-testing negative and potentially discriminatory interactions. Both characteristic styles of coping and episode-specific strategies for coping with ethnic discrimination are examined. Demographic and personality variables likely to affect perceptions of ethnic discrimination will be examined and controlled. Structural equation modeling will be employed to evaluate the relationships among perceived ethnic discrimination to coping and ABP. Additional analyses will examine the association of gender, SES, and race/ethnicity to the use of different styles and strategies for coping with ethnic discrimination, and the effects of these characteristics on the relationship of coping to ABP. The study has implications for theories concerning the relationship of psychosocial stress to risk for HT and for the development of interventions to reduce racial disparities in health status.